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        <h1>
            Myocardial infarction</h1>
        <h5 class="updated">
            Last updated: Friday, 06, August, 2010</h5>
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                    <th>
                        Key Information</th>
                    <th class="description">
                        Appropriate Tests</th>
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                <td class="first">
                </td>
                <td class="second">
                    <p>
                        Hospital admission should not be deferred, pending investigation.&nbsp;</p>
                    <p>
                        Laboratory investigations complement clinical and electrocardiographic 
                        assessment, especially if the latter is normal or shows a non-specific 
                        abnormality or left bundle branch block.</p>
                    <p>
                        Chemical tests vary in the onset and duration of abnormality and results may be 
                        unavailable, or normal, when a decision on thrombolytic therapy must be made.</p>
                    <p>
                        Serial testing may be necessary in doubtful cases especially when the initial 
                        level is within the reference interval.<br />
                    </p>
                    <p>
                        Tests available include:</p>
                    <p>
                        <b>Cardiac troponin I or T</b> - very sensitive and specific.&nbsp;</p>
                    <p>
                        The test becomes abnormal within 12 hours of commencement of pain, and remains 
                        abnormal for about 7 days.&nbsp; It is the recommended test.</p>
                    <P<B>&gt;Creatine kinase (CK) - sensitive but not specific: recommended only in 
                    conjunction with CKMB.
                    <p>
                    </p>
                    <p>
                        <b>CKMB with CKMB/CK ratio</b> - sensitive and specific, but inferior to 
                        troponin. It is of value to diagnose reinfarction.</p>
                    <p>
                        AST, LD - very low specificity; not recommended.</p>
                    <p>
                        LD isoenzymes - reasonably sensitive and specific, remains abnormal for up to 7 
                        days after onset of pain. It has been superseded by troponin.</p>
                    <p>
                        The group of &#39;cardiac enzymes&#39;, CK, AST and LD, is unsatisfactory for the 
                        reliable diagnosis of myocardial infarction.</p>
                    <p>
                        <b>Myoglobin</b> - very sensitive, but non-specific. Peaks within 4 hours of the 
                        onset of pain. Thus it is of particular value for early exclusion of myocardial 
                        infarction.</p>
                    <p>
                        <b>Serial CKMB</b> or <b>myoglobin</b> can be used to document the response to 
                        thrombolytic or angioplastic therapy: rapid elevation indicates successful 
                        revascularisation.</p>
                    <p>
                        Elevation of <b>LD1</b> indicates a poor outcome is more likely.</p>
                    <p>
                        <b>Creatinine, urea, electrolytes, glucose; FBC.</b> If shock is present: <b>
                        blood gases.</b> If lipid studies are required, blood should be collected within 
                        24 hours, or the studies should be deferred for 8 weeks as cholesterol levels 
                        decrease after myocardial infarction.</p>
                    <p>
                        See also&nbsp;<a 
                            href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=73&amp;Itemid=27">Atherosclerosis: 
                        risk assessment</a>.</p>
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            <h2>
                Glossary Terms</h2>
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                <h4>
                    AST :</h4>
                <p>
                    Aspartate aminotransferase</p>
                <h4>
                    CK :</h4>
                <p>
                    Creatine kinase</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    LD :</h4>
                <p>
                    Lactate dehydrogenase</p>
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            ISSN 1449-8219</p>
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